The effect of hypothetical injury on collective efficacy in collegiate soccer teams

Injuries are common in collegiate sport, and most sport injury research has focused on the consequences of injuries for the individual athlete (e.g., stress, frustration, decreased confidence). Very little is known about how injury may impact the team. Recent data using actual injury and hypothetical injury scenarios show that injury impacts a team's collective efficacy (Damato et al., 2008; Edmonds et al., 2009). This research has focused on elite, primarily male samples, and has used sport-specific measures of collective efficacy making results difficult to generalize to other sport populations. The Collective Efficacy Questionnaire for Sports (CEQS; Short, Sullivan, & Feltz, 2005) was developed to eliminate this limitation and can be used to measure collective efficacy beliefs across sports. The purpose of this study was to examine how a team's collective efficacy might change as a result of a teammate's injury in collegiate athletes. A sample of 17 intact NCAA Division I, II, and III intercollegiate soccer teams (9 women's, 8 men's) completed the Collective Efficacy Questionnaire for Sports (CEQS; Short, Sullivan, & Feltz, 2005) before and after being presented with a hypothetical scenario depicting the loss of a teammate due to injury. Results of a 3-level hierarchical linear model revealed a significant main effect for time (p < .001), indicating that team perceptions of collective efficacy decreased following the hypothetical injury of a team member. These findings support initial research that consequences of sport injury extend beyond the individual athlete and may affect team function. Findings also extend existing research with adults to include collegiate athlete populations of both genders. Recognizing that injury can alter team efficacy suggests that athletes, coaches, and sports medicine staff may need to consider a broader psychosocial perspective of sport injury consequences

Impact of climate change and development scenarios on flow patterns in the Okavango River

This paper lays the foundation for the use of scenario modelling as a tool for integrated water resource management in the Okavango River basin. The Pitman hydrological model is used to assess the impact of various development and climate change scenarios on downstream river flow. The simulated impact on modelled river discharge of increased water use for domestic use, livestock, and informal irrigation (proportional to expected population increase) is very limited. Implementation of all likely potential formal irrigation schemes mentioned in available reports is expected to decrease the annual flow by 2% and the minimum monthly flow by 5%. The maximum possible impact of irrigation on annual average flow is estimated as 8%, with a reduction of minimum monthly flow by 17%. Deforestation of all areas within a 1 km buffer around the rivers is estimated to increase the flow by 6%. However, construction of all potential hydropower reservoirs in the basin may change the monthly mean flow distribution dramatically, although under the assumed operational rules, the impact of the dams is only substantial during wet years. The simulated impacts of climate change are considerable larger that those of the development scenarios (with exception of the high development scenario of hydropower schemes) although the results are sensitive to the choice of GCM and the IPCC SRES greenhouse gas (GHG) emission scenarios. The annual mean water flow predictions for the period 2020-2050 averaged over scenarios from all the four GCMs used in this study are close to the present situation for both the A2 and B2 GHG scenarios. For the 2050-2080 and 2070-2099 periods the all-GCM mean shows a flow decrease of 20% (14%) and 26% (17%) respectively for the A2 (B2) GHG scenarios. However, the uncertainty in the magnitude of simulated future changes remains high. The simulated effect of climate change on minimum monthly flow is proportionally higher

Visualizing Cancer

Imaging has had a profound impact on our ability to understand and treat cancer. We invited some experts to discuss imaging approaches that can be used in various aspects of cancer research, from investigating the complexity and diversity of cancer cells and their environments to guiding clinical decision-making

Evaluating the effectiveness of different approaches to home support for people in later stage dementia:A protocol for an observational study

Background: Dementia is a major health problem with a growing number of people affected by the condition, both directly and indirectly through caring for someone with dementia. Many live at home but little is known about the range and intensity of the support they receive. Previous studies have mainly reported on discrete services within a single geographical area. This paper presents a protocol for study of different services across several sites in England. The aim is to explore the presence, effects and cost-effectiveness of approaches to home support for people in later stage dementia and their carers. Methods: This is a prospective observational study employing mixed methods. At least 300 participants (people with dementia and their carers) from geographical areas with demonstrably different ranges of services available for people with dementia will be selected. Within each area, participants will be recruited from a range of services. Participants will be interviewed on two occasions and data will be collected on: their characteristics and circumstances; quality of life; carer health and burden; and informal and formal support for the person with dementia. The structured interviews will also collect qualitative data to explore the perceptions of older people and carers. Conclusions: This national study will explore the components of appropriate and effective home support for people with late stage dementia and their carers. It aims to inform commissioners and service providers across health and social care

The AEDUCATE Collaboration. Comprehensive antenatal education birth preparation programmes to reduce the rates of caesarean section in nulliparous women. Protocol for an individual participant data prospective meta-analysis

Introduction: Rates of medical interventions in normal labour and birth are increasing. This prospective meta-analysis (PMA) proposes to assess whether the addition of a comprehensive multicomponent birth preparation programme reduces caesarean section (CS) in nulliparous women compared with standard hospital care. Additionally, do participant characteristics, intervention components or hospital characteristics modify the effectiveness of the programme? Methods and analysis: Population: women with singleton vertex pregnancies, no planned caesarean section (CS) or epidural. Intervention: in addition to hospital-based standard care, a comprehensive antenatal education programme that includes multiple components for birth preparation, addressing the three objectives: preparing women and their birth partner/support person for childbirth through education on physiological/hormonal birth (knowledge and understanding); building women’s confidence through psychological preparation (positive mindset) and support their ability to birth without pain relief using evidence-based tools (tools and techniques). The intervention could occur in a hospital-based or community setting. Comparator: standard care alone in hospital-based maternity units. Outcomes: Primary: CS. Secondary: epidural analgesia, mode of birth, perineal trauma, postpartum haemorrhage, newborn resuscitation, psychosocial well-being. Subgroup analysis: parity, model of care, maternal risk status, maternal education, maternal socio-economic status, intervention components. Study design: An individual participant data (IPD) prospective meta-analysis (PMA) of randomised controlled trials, including cluster design. Each trial is conducted independently but share core protocol elements to contribute data to the PMA. Participating trials are deemed eligible for the PMA if their results are not yet known outside their Data Monitoring Committees. Ethics and dissemination: Participants in the individual trials will consent to participation, with respective trials receiving ethical approval by their local Human Research Ethics Committees. Individual datasets remain the property of trialists, and can be published prior to the publication of final PMA results. The overall data for meta-analysis will be held, analysed and published by the collaborative group, led by the Cochrane PMA group. Trial registration number: CRD42020103857

Components, impacts and costs of dementia home support: a research programme including the DESCANT RCT

BackgroundOver half of people with dementia live at home. We know little about what home support could be clinically effective or cost-effective in enabling them to live well.ObjectivesWe aimed to (1) review evidence for components of home support, identify their presence in the literature and in services in England, and develop an appropriate economic model; (2) develop and test a practical memory support package in early-stage dementia, test the clinical effectiveness and cost-effectiveness of routine home support in later-stage dementia and design a toolkit based on this evidence; and (3) elicit the preferences of staff, carers and people with dementia for home support inputs and packages, and evaluate the cost-effectiveness of these approaches in early- and later-stage dementia.DesignWe undertook (1) an evidence synthesis, national surveys on the NHS and social care and an economic review; (2) a multicentre pragmatic randomised trial [Dementia Early Stage Cognitive Aids New Trial (DESCANT)] to estimate the clinical effectiveness and cost-effectiveness of providing memory aids and guidance to people with early-stage dementia (the DESCANT intervention), alongside process evaluation and qualitative analysis, an observational study of existing care packages in later-stage dementia along with qualitative analysis, and toolkit development to summarise this evidence; and (3) consultation with experts, staff and carers to explore the balance between informal and paid home support using case vignettes, discrete choice experiments to explore the preferences of people with dementia and carers between home support packages in early- and later-stage dementia, and cost–utility analysis building on trial and observational study.SettingThe national surveys described Community Mental Health Teams, memory clinics and social care services across England. Recruitment to the trial was through memory services in nine NHS trusts in England and one health board in Wales. Recruitment to the observational study was through social services in 17 local authorities in England. Recruitment for the vignette and preference studies was through memory services, community centres and carers’ organisations.ParticipantsPeople aged > 50 years with dementia within 1 year of first attendance at a memory clinic were eligible for the trial. People aged > 60 years with later-stage dementia within 3 months of a review of care needs were eligible for the observational study. We recruited staff, carers and people with dementia for the vignette and preference studies. All participants had to give written informed consent.Main outcome measuresThe trial and observational study used the Bristol Activities of Daily Living Scale as the primary outcome and also measured quality of life, capability, cognition, general psychological health and carers’ sense of competence.MethodsOwing to the heterogeneity of interventions, methods and outcome measures, our evidence and economic reviews both used narrative synthesis. The main source of economic studies was the NHS Economic Evaluation Database. We analysed the trial and observational study by linear mixed models. We analysed the trial by ‘treatment allocated’ and used propensity scores to minimise confounding in the observational study.ResultsOur reviews and surveys identified several home support approaches of potential benefit. In early-stage dementia, the DESCANT trial had 468 randomised participants (234 intervention participants and 234 control participants), with 347 participants analysed. We found no significant effect at the primary end point of 6 months of the DESCANT intervention on any of several participant outcome measures. The primary outcome was the Bristol Activities of Daily Living Scale, for which scores range from 0 to 60, with higher scores showing greater dependence. After adjustment for differences at baseline, the mean difference was 0.38, slightly but not significantly favouring the comparator group receiving treatment as usual. The 95% confidence interval ran from –0.89 to 1.65 (p = 0.56). There was no evidence that more intensive care packages in later-stage dementia were more effective than basic care. However, formal home care appeared to help keep people at home. Staff recommended informal care that cost 88% of formal care, but for informal carers this ratio was only 62%. People with dementia preferred social and recreational activities, and carers preferred respite care and regular home care. The DESCANT intervention is probably not cost-effective in early-stage dementia, and intensive care packages are probably not cost-effective in later-stage dementia. From the perspective of the third sector, intermediate intensity packages were cheaper but less effective. Certain elements may be driving these results, notably reduced use of carers’ groups.LimitationsOur chosen outcome measures may not reflect subtle outcomes valued by people with dementia.ConclusionsSeveral approaches preferred by people with dementia and their carers have potential. However, memory aids aiming to affect daily living activities in early-stage dementia or intensive packages compared with basic care in later-stage dementia were not clinically effective or cost-effective.Future workFurther work needs to identify what people with dementia and their carers prefer and develop more sensitive outcome measures.Study registrationCurrent Controlled Trials ISRCTN12591717. The evidence synthesis is registered as PROSPERO CRD42014008890.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information